Wednesday, 10 December 2014

Political Odds and Ends on Health

The Politics of Health

“Senator Zoe Cameron spent the weekend considering her position and whether she could have an impact on the future of Island healthcare as a backbench politician. A political newcomer, her election campaign focussed strongly on Jersey’s health system. However, after voicing her desire to be Health Minister she lost out on the role to Senator Andrew Green.” (JEP)

I’ve heard suggestions that some higher officials at health may have briefed Senator Green about Zoe Cameron regarding her not getting the position of Assistant Minister. I don’t know how true that is, but it does remind me of the Yes Minister Diaries, especially when you hear that she was told by some States members that "it was inappropriate to work in an area where you had expert knowledge" (JEP)

Hacker says: “I was expecting to be Minister of Agriculture, as I've shadowed Agriculture for seven years, and have many good ideas about it, but for some inexplicable reason the PM decided against this.”

And the reason is revealed as follows:

“We found a memo from Sir Andrew Donnelly, Permanent Secretary of Agriculture, to Sir Arnold Robinson, Secretary to the Cabinet, imploring Sir Arnold to make sure that Hacker did not get Agriculture as he was too ‘genned up' on it. Cabinet Papers show that Sir Arnold managed to convey to the PM that it would be better for Hacker not to go to Agriculture because ‘he's been thinking about it rather too long and is perhaps in a bit of a rut'”

Is that along the lines of what happened here? Surely no one in the health service could be anything like the mandarins in Yes Minister, and give briefings against her?

I tend to be rather cynical about civil servants, ever since Bill Ogley left with a pot of gold, having decided he couldn't work with Senator Ozouf. Bill Ogley, it should be remembered, also organised a good leaving deal of £125,000 for his chum, Mike Pollard, whose wife was also in Assistant Director of Human Resources at the time. Bill Ogley also organised what appeared to be an unminuted meeting to brief Chief Officers against Stuart Syvret, which we only know about because Graham Power was so concerned he made a file note.

Of course that is in the past, but has the culture of secrecy and backroom briefings wholly changed?

Pot Luck?

On the subject of health, I see that Andrew Green turned down the request of Ann Hill (a multiple sclerosis patient,) for Sativex a legal, cannabis-based medication not on grounds of legality but on grounds of cost. It was already available privately but would cost £5,000 per annum per patient.

In fact the cost varies widely, and the drug is not suitable anyway for most patients. The Sativex website notes that:

“Sativex is indicated as treatment for symptom improvement in adult patients with moderate to severe spasticity due to multiple sclerosis (MS) who have not responded adequately to other anti-spasticity medication and who demonstrate clinically significant improvement in spasticity related symptoms during an initial trial of therapy”

And notes that:

“Five patients per 100,000 of the general population are likely to be eligible for ongoing treatment with Sativex, which means its budget impact is limited (2-5).”

And they give an estimate cost of £10,070.55 per year.

A Multiple Sclerosis blog looks at an academic study in 2012 and notes that:

“Sativex® appears unlikely to be considered cost effective by UK funders of healthcare for spasticity in MS. This is unfortunate, since it appears that Sativex® use is likely to benefit some patients in the management of this common consequence of MS.”

The Vale of York Commissioning group came with a cost of £2798 to £5596 a year, and notes that:

“It is estimated 9 per 100,000 population would be treated with sativex of which 4 would continue after 1 month. This would equate to £11,192 - £22,384 per 100,000 population per year.”

Why the high cost? Dr Rick Bayer, fellow in the American College of Physicians, and a proponent for medical marijuana to relieve pain and other debilitating conditions, notes that:

“Although Sativex is expected in Europe soon, US regulators delayed approval by requiring a tamper-proof delivery system to ‘lock’ the number of doses patients can access. This will cause delay and add expense to the product.”

And in fact the cost appears to derive in part from the manufacturer having an effective monopoly on the market – and an exclusive exception to British law by means of licence. It is actually produced in Britain, not in the USA where it is mostly sold, which may come as a surprise:

“GW Pharmaceuticals is the only company in the UK with a license to produce medical marijuana. The company harvests an estimated 300 tons (600,000 pounds) of cannabis every year for the manufacturing of Sativex and the R&D of other marijuana-derived medications. “

“Although this allows GW Pharmaceuticals to conduct extensive investigations into the safety and benefits of Sativex, it also restricts patients from considering medical cannabis as an alternative. Likewise, Sativex comes at a much higher price to patients in the UK, priced at £125 for a 10ml vial.”

And the high cost is a problem, but it seems as if alternatives may be coming on the market at cheaper prices from the USA itself.

“Most PCTs and health authorities are refusing to fund Sativex because of the extraordinarily high price that GW and its UK distributors Bayer want to charge the NHS. At about £175 per bottle, Sativex costs around 10 times what organised crime sells cannabis for on the streets. Products that are pharmacologically identical to Sativex are available from medical marijuana dispensaries in the US for around $20 per bottle”

Clearly, they would need to be licensed, especially by the FDA before the UK took an interest, and there would probably be some resistance from GW Pharmaceuticals, but it does I think point the way forward to the future.

Competition is not always good for the market, but neither are monopolies, especially for those who suffer chronic and debilitating conditions.


1 comment:

Dizzy Ringo said...

During the elections we had the opportunity, taken by few, to discuss the use of cannabis with a young man paralysed from the chest down. He stated that it stopped the spasaming that he was subject to. However he cannot get medical pot legally so we have the unedifying sight of a young man in a wheel chair appearing in Court for the possession of 2 cannabis plants.
I am told that there are two medial components of marijuana - one which makes you high and one which calms pain and spasms. Proper cultivation should produce plants with lots of the anti pain and spasming component and not much "high" component.